Active NPI
Mahalia McCoy, RN,FNP
- General Practice Registered Nurse
- Fremont, CA
National Provider Identifier
1154885036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Registered Nurse
- License
- 579704
- Practice address
- 4649 Victoria Park CT
Fremont, CA 94538-4057 - Phone
- (601) 946-6675
- NPI assigned
- Jan 25, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 579704 | CA | Primary |
Addresses
Primary practice location
4649 Victoria Park CT
Fremont, CA 94538-4057
Mailing address
4649 Victoria Park CT
Fremont, CA 94538-4057
Phone (601) 946-6675
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 579704 | Other | CA | BOARD OF NURSING |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 579704 | CA | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548374400000",
"number": "1154885036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4649 VICTORIA PARK CT",
"city": "FREMONT",
"state": "CA",
"postal_code": "945384057",
"telephone_number": "601-946-6675"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4649 VICTORIA PARK CT",
"city": "FREMONT",
"state": "CA",
"postal_code": "945384057",
"telephone_number": "601-946-6675"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCOY",
"first_name": "MAHALIA",
"name_prefix": "Mrs.",
"credential": "RN,FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-25",
"last_updated": "2019-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "CA",
"license": "579704",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF NURSING",
"identifier": "579704",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.